Basic Information
| Provider Information | |||||||||
| NPI: | 1578731527 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WILLIAMS | ||||||||
| FirstName: | MARK | ||||||||
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| NamePrefix: | MR. | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 27 N MAIN ST | ||||||||
| Address2: | SUITE 225 | ||||||||
| City: | HOMER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 130771314 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6077492219 | ||||||||
| FaxNumber: | 6077492286 | ||||||||
| Practice Location | |||||||||
| Address1: | 225 BROADWAY | ||||||||
| Address2: | SUITE 2120 | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100073001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2127322100 | ||||||||
| FaxNumber: | 2127322105 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/12/2008 | ||||||||
| LastUpdateDate: | 03/22/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 030077-1 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.